Tranexamic Acid and Safety in the Right Patient

Holcomb, John B.; Sauaia, Angela; Cardenas, Jessica C.

doi:10.1001/jamasurg.2021.0929

Cited by 3 publications

(3 citation statements)

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“…Thus, the studies reported some VTE rates in the TXA and placebo groups that were below the known standard risk in corresponding populations, for example in European industrialised countries [29,30,31]. It also remains unclear which patient group is most likely to benefit from TXA administration [32].…”

Section: Background and Clinically Relevant Issuesmentioning

confidence: 99%

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The Perioperative Application of Tranexamic Acid

et al. 2023

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The application of tranexamic acid (TXA) during endoprosthetic surgical procedures has significantly increased in recent years. Due its ability to reduce perioperative blood loss and avert the need for blood transfusions as well as wound drainage, TXA is becoming part of a ‘standard practice’. However, TXA is currently not approved for the application during endoprosthetic procedures and therefore, a benefit-risk analysis should always be conducted. Prophylactic administration of TXA without prior patient consent is only justified if fibrinolytic bleeding is expected and there are no contraindications or relevant risk factors for thromboembolic complications. Respectively, no patient consent is required when a therapeutic dose of TXA is administered in the context of fibrinolytic bleeding. The following guidelines provide updated recommendations based on the current state of knowledge on TXA optimal timing, routes of administration and dosing regimen.

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Section: Background and Clinically Relevant Issuesmentioning

confidence: 99%

“…B. europäischen Industrienationen lagen [29,30,31]. Auch bleibt unklar, welche Patient*innen-Gruppe am ehesten von einer TXA-Gabe profitiert [32].…”

Section: Hintergrund Und Klinisch Relevante Fragenunclassified

The Perioperative Application of Tranexamic Acid

et al. 2023

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“…Given the clot-stabilising properties of antifibrinolytic drugs, there are concerns about the potential for TXA to increase the risk of arterial or venous thromboembolic events. Nonetheless, a growing body of evidence has demonstrated the safety of TXA in joint arthroplasty, especially with regard to venous thromboembolic events [17][18][19], but the full safety profile, especially for rare adverse outcomes, has not been determined [20,21].…”

Section: Introductionmentioning

confidence: 99%

The safety of tranexamic acid administration in total knee arthroplasty: a population‐based study from Taiwan

Hsu

Hsu²,

et al. 2022

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Summary Tranexamic acid is an effective treatment to reduce blood loss. We performed a retrospective observational study to evaluate safety in unilateral total knee arthroplasty. We utilised Taiwan's national health insurance database to identify relevant patients and to retrieve information on peri‐operative blood transfusions and tranexamic acid administration within 60 days of follow‐up. We examined changes in the rate of transfusions and adverse events with respect to tranexamic acid administration using logistic regression. We observed a total of 226,719 knee arthroplasty cases during 2010–2019. Transfusion and tranexamic acid administration rates were 38.9% (88,258) and 42.9% (97,237), respectively. Tranexamic acid was associated with a 50% decrease in blood transfusions (RR: 0.50, 95%CI: 0.48–0.51). After propensity‐score matching, tranexamic acid was not associated with pulmonary embolism; deep vein thromboembolism; artery vein thromboembolism; acute myocardial infarction; ischaemic stroke; or in‐hospital mortality, but was significantly associated with acute kidney injury. Patients with existing chronic kidney disease suffered a high absolute risk of kidney injury irrespective of tranexamic acid administration (832 per 10,000, 95%CI 797–869). Tranexamic acid was also associated with surgical site infection. There was strong interaction between blood transfusion; tranexamic aid administration; and development of surgical site infection. In conclusion, tranexamic acid use was associated with decreased blood transfusion and was not associated with thromboembolic events. However, careful consideration is required before use in patients with pre‐existing renal disease. Further, our observed interaction between patients given tranexamic acid who subsequently require transfusion requires careful consideration with respect to enhanced prophylaxis against surgical site infection.

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